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Sunday, March 9, 2014
Quality Health Care and You - Diabetes
High MicroAlbumin/Creatinine Ratio
My husband is 38 years old, a diabetic with fasting glucose of 150. He`s hypertensive on medication with blood pressures ranging from 120-145/60-90. His urine albumin-to-creatinine ratio is 150. He is overweight and isn`t a person that drinks a lot of water. He has no complaints of lower back pain or any signs/symptoms that indicate kidney disease. Could this be the beginning of a kidney disorder?
Yes, the presence of microalbuminuria (micro-amounts of albumin in the urine) is an early indication of kidney disease. People with normal kidneys do not have albumin in the urine. With different types of kidney disease, particularly diabetes, the kidney is damaged and leaks protein (or albumin) into the urine. The lab test called the microalbumin-to-creatinine ratio was invented in order to allow detection of this very early sign of kidney damage: a value of greater than 30 indicates small amounts of protein leakage. Current recommendations are to screen diabetics at least once a year for microalbuminuria.
The importance of even this tiny amount of protein in the urine is that its presence predicts:
1) progression to full-blown kidney disease (including "end stage renal disease," with a need for dialysis)
2) increased risk of developing cardiovascular complications of diabetes
The good news is that, at this stage with proper treatment, the damage may possibly be reversed or at least prevented from progressing. Certain medications (especially the so-called "ACE inhibitors" such as lisinopril and enalapril, and "ARBs" such as losartan and valsartan) are very helpful in decreasing protein excretion. Other therapies that are extremely important are good control of blood pressure, excellent control of diabetes, and treatment of cholesterol/lipid abnormalities.
I am concerned about your husband's fasting blood sugars of up to 150. The value of 150 is on the high side, but more importantly, the fasting blood sugar provides only a tiny glimpse of what a person's blood sugar is doing throughout the days and weeks. A better measure of blood sugar control is the hemoglobin A1C, which takes into account the hourly and daily ups and downs of blood sugar over a 3-month period. Normal A1C is less than 6%, and good diabetic control is considered to be less than 7%. It would be worthwhile for him to discuss this test with his doctor.
Also, please note that kidney disease in diabetes does not cause pain, so back or flank pain is not expected even in far advanced kidney failure. And the amount of water that a person drinks (with few exceptions, such as kidney stones) neither helps nor hurts their kidney function. Much more important to kidney health is affected by:
- Control of blood pressure, blood sugar, and cholesterol
- Weight loss
- Cessation of smoking
Good luck to your husband, and I hope that he will do the things that he needs to do at this time, when he still has the opportunity to prevent progression of his kidney damage.
Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University